Recovery-oriented
services for people with mental illness are best practices, yet related
education and training is not well developed. This article highlights
an approach – TEACH (Theory, Evidence, Action in Care for Health) – to
facilitate recovery-oriented education and training. Research about
TEACH and other recovery-oriented education and training approaches is
needed.

Introduction:

Providing
recovery-oriented services assumes that providers are educated and
trained appropriately. Such education and training in relation to
recovery and related services requires teachers to be recovery-oriented
in the education and training they provide to learners. There is no
generally accepted framework to guide such education and training. In
this paper, I report an education and training framework – TEACH
(Theory, Evidence, Action in Care for Health) – that I have developed,
and its application to recovery-oriented education and training.

Sound
education and training uses theory, empirical evidence and practice
(action) iteratively and contextually. Thus, all three TEACH components
should be used by recovery-oriented teachers. In relation to theory,
recovery-oriented teachers can use theories of psychiatric
rehabilitation (among other theories), such as Anthony et al’s
formulation of environments of choice (Anthony, Cohen, Farkas, &
Gagne, 2002). In relation to evidence, recovery-oriented teachers can
use evidence such as facts about recovery-oriented systems and services
(Nelson, Kloos, & Ornelas, 2014). In relation to action,
recovery-oriented teachers can use practice such as exercises for
person-centered care planning (Tondora, Miller, Slade, & Davidson,
2014). This is about the content – the “what” – of education. What
about the process – the “how” – of education?

As noted above,
sound education and training is iterative. In relation to TEACH, this
means that theory, evidence and action inform each other and are taught
in stages and in cycles (or perhaps using a better visual analogy, in
spirals), so that after basic theory, evidence and action are
addressed, often focusing on awareness and knowledge (Knowles, Holton
and Swanson 2011), more advanced level theory, evidence and action are
addressed, often focusing on skills and attitudes (Ibid). The
order of theory, evidence and action may change, although starting with
theory, proceeding to evidence, and continuing with action may make
most sense in many situations. For example, learning about theoretical
aspects of recovery (Rudnick, 2012) and about evidence related to
person-centered care for people with serious mental illness (Rudnick
& Roe, 2011) is conducive to and hence may best precede learning
person-centered care planning (Tondora, Miller, Slade, & Davidson,
2014). That being said, learning style – intellectual, experiential or
other – may determine this order. And teaching style – which is often
ignored – may also contribute to this determination; for an overview of
some teaching styles and a measure to assess them, see the teaching
perspectives inventory
(https://facultycommons.macewan.ca/wp-content/uploads/TPI-online-resource.pdf),
which addresses five teaching styles that each teacher exhibits to a
smaller or larger extent – 1. transmission, which is knowledge focused;
2. apprenticeship, which is skills focused; 3. developmental, which is
reasoning focused; 4. nurturing, which is support focused; and 5.
social reform, which is values focused.

Sound education and
training is also contextual. In relation to TEACH, that means that
relevance or pertinence of theory, evidence and action is imperative.
For example, Anthony and colleagues use theory from physical
rehabilitation to teach psychiatric rehabilitation (Anthony, Cohen,
Farkas, & Gagne, 2002). And although the conventional biomedical
model of care is foreign to a recovery-oriented approach, clinical
communication practice that was developed for medical education
purposes can be useful in recovery-oriented education and training, as
in the teaching of structured empathic communication (Buckman, 2010).

An
illustration of TEACH based on some of my psychiatric rehabilitation
education and training innovation (Rudnick & Eastwood, 2013) may be
relevant and helpful. For example, when teaching psychiatric
rehabilitation to obtain and maintain success and satisfaction in
social environments of choice, basic theory can be related to social
behavior and to stigma and advanced theory can be related to social
cognition and to structural inequalities in society; basic evidence can
be related to effects of social skills training and to stigma reduction
and advanced evidence can be related to effects of social cognition
remediation and to advocacy; and basic practice can be related to
social skills training and to stigma reduction while advanced practice
can be related to social cognition remediation training and to advocacy
training. Applying TEACH facilitates staging and otherwise
individualizing such education and training, so that teachers can help
learners customize such education and training, using a fairly
structured and reasoned approach. Thus, an intellectually oriented
learner who has no knowledge of this area of psychiatric rehabilitation
would likely need to start with learning about social behavior and
stigma, and then proceed to learn about and practice social skills
training and stigma reduction. An experientially oriented learner who
has already learned social skills training would likely benefit from
social cognition remediation training and advocacy training.

In
summary, TEACH is a framework that is applicable to recovery-oriented
education and training. Research about, as well as further development
and attempted implementation of, TEACH and other frameworks for
recovery-oriented education and training are needed.